Objective To investigate the clinical utility of iFlow color flow coding imaging technology in the diagnosis of lower extremity arteriosclerosis obliterans （LEASO）. Methods A total of 106 patients diagnosed with LEASO between March 2022 and October 2023 were included as the LEASO group， while 80 volunteers without arterial disease but matched with LEASO were selected as the control group. Both groups underwent digital subtraction angiography （DSA）， and iFlow color flow coding imaging technology was employed to assess time to peak （TTP） in the femoral head and ankle regions. The difference value of TTP between these two regions was calculated， along with measurement of ankle-brachial index （ABI）. Results There were no significant differences in age， sex， body mass index， smoking history， hypertension history， diabetes history， coronary heart disease history and TTP in the femoral head between the two groups （P > 0.05）. However， the TTP in the ankle area and the difference values of TTP in the LEASO group were significantly higher than those in the control group （P < 0.05）. The comparison of TTP in the femoral head region among patients with different Rutherford classifications and between patients with left and right lesions in the LEASO group showed no statistical significance （P > 0.05）. Furthermore， a negative correlation was observed between Rutherford classification and both TTP values in ankle joint region as well as TTP difference value （P < 0.05）， indicating that higher Rutherford classification is associated with lower TTP values. Pearson test results revealed a significant negative correlation between TTP values and ankle joint region/TTP difference value of LEASO patients with ABI （ P < 0.05）. Receiver operating characteristic curve analysis demonstrated that both TTP values in ankle joint region and TTP difference value are effective diagnostic indicators for LEASO； moreover， Delong test indicated that area under ROC curve for TTP difference value was significantly higher than that for TTP value alone （P < 0.05） Conclusion iFlow color flow coding imaging technology enables quantitative assessment of both TPP values within ankle joint region as well as their differences which can be utilized for diagnosis of LEASO.